Menopause and ovarian insufficiency are common side-effects that biological females can get if you’ve had treatment for lymphoma before natural menopause. Menopause naturally occurs when we are between 45-55 years of age, however it can happen earlier if you have had chemotherapy, some immunotherapies or radiation to your abdomen or pelvic area.Â
Whether you want children or not, menopause and ovarian insufficiency can have unwanted symptoms and complications. Most of these side-effects are temporary, however some may need ongoing treatment.
This page will provide information on the differences between menopause and ovarian insufficiency, and how you can manage symptoms related to them.
Difference between menopause and ovarian insufficiency
Although they may have similar symptoms, menopause and ovarian insufficiency are not the same thing.Â
Menopause
Menopause is when you stop having periods altogether, and are unable to get pregnant. Your ovaries no longer produce hormones at levels that can mature your eggs, line your womb (uterus) or sustain a pregnancy. When menopause happens as a result of chemotherapy treatment it is known as chemotherapy-induced menopause (CIM).Â
Ovarian insufficiency
Ovarian insufficiency is when you still produce hormones, but in irregular amounts. This means that you may still get your periods, but they will be irregular. You may still fall pregnant naturally, but it can be difficult. You may be able to get pregnant with medical assistance such as with invitro fertilisation (IVF).Â
Why do lymphoma treatments cause menopause and ovarian insufficiency?
Treatments for lymphoma can cause menopause or ovarian insufficiency by causing direct damage to your ovaries and eggs or interrupting your body’s ability to produce hormones. Hormones that may result in early menopause or ovarian insufficiency are listed in the table below.
Hormone | Function |
Estrogen | Produced in the ovary’s, fatty tissue and adrenal glands. Needed for the development of breasts during puberty and to line the uterus to prepare for periods (menstruation) or to maintain a pregnancy. Also responsible for healthy bones, muscles, skin, heart, blood sugar and cholesterol levels, nervous system and bladder control. |
Progesterone | Produced by ovaries after ovulation (release of egg) and prepares the uterus for pregnancy and helps the development of the unborn baby. Also needed for the production of breast milk. Other functions of progesterone include healthy thyroid function and mood stabilisation. A small amount of progesterone is also made by the adrenal glands, and by the placenta during pregnancy. |
Testosterone | Produced by ovaries, adrenal glands, fatty tissue and skin cells. Most testosterone in biological females is converted into estrogen. It’s needed for the development of sexual organs, healthy bones and sex drive (libido). |
Luteinising Hormone | Produced by the pituitary gland and needed for the maturing and release of eggs from the ovaries, and to maintain pregnancy. |
Follicle stimulating hormone (FSH) | Produced in the pituitary gland and is needed for ovaries to release eggs. |
Hormones are naturally occuring chemicals in our body that are needed for normal body functions. Some hormones are needed to develop secondary sex characteristics such as breasts, and a healthy reproductive system. They are also needed to mature your eggs so they can be fertilised by sperm, and line your uterus to ensure you have your periods or can maintain a pregnancy.
Hormones also help keep our bones, muscles and heart strong, can affect our mood, voice, skin, weight and can affect our sex drive (libido).
Click on the headings below to learn more about how the different treatments may cause early menopause or ovarian insufficiency.
Chemotherapy can cause early onset menopause or ovarian insufficiency in biological girls and women of any age if you have not already been through natural menopause.Â
This happens because the chemotherapy can damage your ovarian follicles that produce eggs inside your ovaries. The damage to the follicles results in you producing lower, or inconsistent amounts of needed hormones such as estrogen, progesterone and testosterone.Â
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Radiation to your pelvis or abdomen may cause damage and scarring to your ovary’s and destroy many, if not all your eggs. The damaged tissue can also affect your ovary’s ability to produce hormones, leading to lower hormone levels including estrogen, progesterone and testosterone.Â
The effect of radiation on your ovaries depends on the location, dose and duration of therapy. Â
Immune checkpoint inhibitors are a newer treatment for lymphoma and are a type of monoclonal antibody. Their effect on your body is different to other treatments and side-effects are commonly caused by your own immune system rather than the treatment itself.
These treatments work by blocking proteins on the lymphoma cell that they develop, making them look like normal healthy cells. However, your healthy cells have these proteins to. By blocking the proteins, the cells look dangerous to your immune system, so your immune system attacks and eliminates them. This is a good way to destroy your lymphoma cells however. can result in in your immune system attacking your normal health cells too.
Some cells that have these proteins include those in your ovaries, adrenal and pituitary glands which affects their ability to produce the hormones.
Immune checkpoint inhibitors can therefore affect the production of estrogen, progesterone, testosterone, follicle stimulating hormone and luetinising hormone – all needed for healthy reproductive and other bodily functions.
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Zoladex is hormone treatment given as an injection in your tummy. It is given to shut down your ovaries during treatment to give them some protection from lymphoma treatments. It can cause medical induced and temporary menopause.
I don't want a baby, is ovarian insufficiency or early menopause a problem?
Menopause and ovarian insufficiency affect more than just your ability to have a baby. Even if you don’t want to get pregnant, there are other symptoms of menopause and ovarian insufficiency that may concern you or affect your quality of life if not managed properly.
Everyone is different when it comes to side-effects and you may have only one or two side-effects, or you may have many of the listed side-effects below. They may be a minor inconvenience, or they may affect your everyday life dramatically. Knowing what to expect, how to manage the side-effects and when to contact your doctor is important to maintain a good quality of life.
Symptoms of menopause & ovarian insufficiency
It’s important to know that many of these side-effects are temporary. They occur as your body learns to adjust to lower hormones levels, and as your body readjusts and learns what your new normal levels are, some symptoms will naturally improve.
Common symptoms of menopause are listed below.Â
- No more menstrual periods, or irregular periods.
- Inability to get pregnant or carry a pregnancy to term.
- Decreased bone mass (osteoporosis) that can result in broken bones.
- Blood clots.
- Weakness due to loss of muscle mass.
- Cardiac (heart) changes that can affect your blood pressure and heart rate.
- High cholesterol levels in your blood.
- Hot flashes & night sweats.
- Mood swings including sadness or depression, anger, loss of patience.
- Vaginal dryness and/or weakened vaginal walls.
- Decreased sex drive or sexual sensitivity making it difficult to reach orgasm.
- Insomnia and fatigue.
- Difficulty concentrating.
- Incontinence (difficulty making it to the toilet on time).
- Weight gain.Â
Extra symptoms for girls who are going through or have not reached puberty.
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- Delayed onset of periods.
- Delayed development of female secondary sexual characteristics such as breasts, widening of hips and pubic hair.
- Mood and self-esteem changes.
- Weight gain especially around the abdomen (tummy).
- Delayed interest in sex and romantic relationships.
- General weakness and frailty.
Tests you may need
Report all new and worsening symptoms to your haematologist, oncologist or general practitioner (GP). They will be able to assess the severity of your symptoms and check your hormone levels with a blood test to determine if you are in menopause or ovarian insufficiency.Â
If you are in menopause or have ovarian insufficiency there are some tests you should have to check your risk of complications such as heart disease or osteoporosis. Knowing your risk can help you work with your medical team to prevent or minimise any symptoms or complications. Some tests you may need include:
- Blood tests to check hormone levels, Vitamin D, clotting factors, cholesterol and other markers depending on your individual circumstances.
- Bone density scan.
- Psychosocial assessment.
- Vital signs including heart rate and blood pressure.
- Tests on your heart such as an ultrasound (ECHO) or electrocardiogram (ECG).
Treatment of menopause and ovarian insufficiency
You may need hormone replacement therapy (HRT) to replace the hormones you are no longer able to naturally produce. HRT can be given as tablets, patches that you stick to your skin, as creams or gels. If you have vaginal dryness, you may be able to have hormonal cream or gel that goes into your vagina to make you more comfortable and prevent painful intercourse (sex).
Hormone replacement therapy will help improve some of your symptoms but is also important to help prevent some of the more serious complications such as heart and bone disease. However, if you have ever had a cancer that is fueled by hormones such as some types of breast and ovarian cancer, let your medical team know so they can work out if HRT is the best option for you.Â
HRT should continue until you reach an age where you would naturally go through menopause. Natural menopause normally happens between the ages of 45 and 55 years. Talk with your doctor before stopping HRT.
Click on the headings below to learn more about managing the effects.
Low levels of estrogen put you at risk of osteoporosis which is a condition where your bones become weaker and can break more easily. Preventing the bone loss that comes with osteoporosis is an important part of managing early menopause and ovarian insufficiency.Â
You can help to maintain or strengthen you bones by:
- Not starting, or giving up smoking. Talk to your pharmacist, doctor or nurse about what help there is to help you give up.
- Regular weight-bearing exercise (at least 3 times every week). Weight bearing exercises are when you support your own weight, such as when you walk, jog, dance, climb stairs or play most sports (not including swimming or bicycling).
- Ensure you get enough calcium and vitamin D in your diet. Ask your doctor if you need supplements.
- Taking hormone replacement therapy as prescribed.
You may have an increased risk of cardiovascular disease when you have early menopause or ovarian insufficiency. Cardiovascular disease refers to conditions that affect your heart and blood vessels. Some of these can be very serious so it is important to know your risk and put strategies in place to minimise the effect these can have on your life.Â
Some things you can do include:
- Maintain a healthy weight. If you need help with this, ask your doctor for a referral to an exercise physiologist or dietician.
- Do not start, or give up smoking – your doctor can help if you need to give up.
- Mange other conditions well (such as blood pressure, diabetes and cholesterol levels). Ask your doctor to check these and help you make a plan to control them.
- Take you Hormone Replacement Therapy as prescribed by your doctor.
For more information on heart changes click here.Â
Getting pregnant after treatment when you have menopause or ovarian insufficiency can be difficult. Sadly, in some cases a pregnancy may not be possible even with medical help.
Hopefully you had time to collect eggs or ovarian tissue before you started treatment. If you have not yet started treatment and want to know about preserving fertility, click here.
Changes in hormones levels can have a significant effect on your mood and emotions. You may find little things that would not have worried you in the past upset you greatly. You may cry for no reason, feel overwhelmed or have mood swings.
You are not going crazy! Your body is adjusting to lower levels of hormones, and some of these hormones help to regulate your moods and emotions. On top of this, going through treatment for lymphoma, and now having early menopause or ovarian insufficiency which may impact your plans for a family in the future, all take a toll on your mood and emotions.
As your body adjusts to the lower hormone levels your mood and emotions should even out to what they were before treatment. However, if early menopause or ovarian insufficiency has impacted your life in other ways, such as having children, or other complications such as heart or bone disease, it is normal to feel upset about this.
There is help available. You can reach out to our Lymphoma Nurse by clicking on the contact us button at the bottom of the screen. They are here to listen to your concerns or worries and can help by providing information on what support is available to you.
Also talk to your doctor. You GP can make a mental health plan with you to make sure you get the right support to help manage your mood and emotions. They can also organise referrals for you to see different specialists that can help you.
Other symptoms you get will have similar management strategies to those caused by your lymphoma treatments. For more information on managing other symptoms and side-effects, click on the link below.
Some symptoms of early menopause and ovarian insufficiency are similar to symptoms of lymphoma or side-effects of treatment. Always report your symptoms so you can be assessed and know the cause of symptoms and best treatment options.
Other specialists you may need
You may need some extra support to manage the side-effects or complications of early menopause and ovarian insufficiency. Below is a list of other health professionals that may be able to help you manage these and improve your quality of life.
General practitioner (GP) is your local doctor and are a very important of your ongoing care during and after your lymphoma treatment. They can help you manage side-effects and make GP management plan or mental health management to coordinate your health care needs over the next year. Your GP can refer to the specialist below if needed to help you manage the effects of early menopause or ovarian insufficiency.
Endocrinologists are doctors with extra training at managing conditions related to hormones.
Cardiologist are doctors with extra training in managing conditions affecting your cardiovascular system.
Psychologists are members of the health care team and can help you manage your thoughts, mood and feelings all of which can be affected by your lymphoma, its treatments and early menopause and ovarian insufficiency.
Dieticians are universtiy trained members of the allied health care team who can help you make a plan for you diet within your budget that icnluces foods you like. They make sure that you get the right amount of calories and the needed nutrition to manage your weight and keep you healthy.
Exercise physiologists and physiotherapists are university trained allied health professionals who can help you make a safe exercise plan to keep your bones as strong as possible, within your individual limits.
Fertility specialists may be needed if you want to get pregnant after treatment for lymphoma. To learn more about fertility after treatment please click here.
Summary
- Many different types of treatment for lymphoma can cause early menopause or ovarian insufficiency.
- If you have not yet started treatment, please see our Fertility page to learn about option to increase your chance of getting pregnant after treatment.
- All biological females who have not already gone through natural menopause can be affected, including young girls who have not reached puberty.
- You will likely need medical help to get pregnant if you have early menopause or ovarian insufficiency, though in some cases pregnancy may not be possible. See our Fertility after treatment page for more information.
- Even if you don’t want to get pregnant, complications from early menopause or ovarian insufficiency may affect you and need follow-up tests and treatment.
- Your GP will be an important person in your follow up care and can help organise referrals tests and follow-up care.
- You may need different health professionals involved in your care to give you the best quality of life.
- Our Lymphoma Care Nurses can also provide support and advice.Â
